Fibrous marker and intracorporeal delivery thereof

ABSTRACT

An intracorporeal marker delivery system includes a delivery device including a delivery cannula and a plunger. The delivery cannula has an inner lumen, a distal tip, and a discharge opening in communication with the inner lumen. A radiographically detectable marker having a fibrous-body and a radiographically detectable marker element coupled to the fibrous body is disposed within and pushable by the plunger through the inner lumen of the delivery cannula. An MRI detectable distal tip plug is disposed at least in part within a distal portion of the inner lumen distal to the radiographically detectable marker, and configured to partially occlude the discharge opening in the delivery cannula. An ultrasound detectable short term marker is interposed between the radiographically detectable marker and the MRI detectable distal tip plug in the inner lumen of the delivery cannula.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/946,175, filed Jul. 19, 2013, now U.S. Pat. No. 8,880,154, which is acontinuation of U.S. patent application Ser. No. 13/155,628, filed Jun.8, 2011, now U.S. Pat. No. 8,626,269, which is a continuation of U.S.patent application Ser. No. 10/444,770, filed May 23, 2003, now U.S.Pat. No. 7,983,734, entitled, “FIBROUS MARKER AND INTRACORPOREALDELIVERY THEREOF”, each of which is incorporated herein by reference inits entirety.

FIELD OF THE INVENTION

The invention is directed generally to a fibrous marker and devices andsystems for the intracorporeal delivery thereof to a target site withina patient.

BACKGROUND OF THE INVENTION

In diagnosing and treating certain medical conditions, it is oftendesirable to mark a suspicious body site for the subsequent taking of abiopsy, delivery of medicine, radiation, or other treatment, to mark alocation from which a biopsy was taken, or at which some other procedurewas performed. As is known, obtaining a tissue sample by biopsy and thesubsequent examination are typically employed in the diagnosis ofcancers and other malignant tumors, or to confirm that a suspectedlesion or tumor is not malignant. The information obtained from thesediagnostic tests and/or examinations is frequently used to devise atherapeutic plan for the appropriate surgical procedure or other courseof treatment.

In many instances, the suspicious tissue to be sampled is located in asubcutaneous site, such as inside a human breast. To minimize surgicalintrusion into a patient's body, it is often desirable to insert a smallinstrument, such as a biopsy needle, into the body for extracting thebiopsy specimen while imaging the procedure using fluoroscopy,ultrasonic imaging, x-rays, magnetic resonance imaging (MRI) or anyother suitable form of imaging technique. Examination of tissue samplestaken by biopsy is of particular significance in the diagnosis andtreatment of breast cancer. In the ensuing discussion, the biopsy andtreatment site described will generally be the human breast, althoughthe invention is suitable for marking biopsy sites in other parts of thehuman and other mammalian body as well.

Periodic physical examination of the breasts and mammography areimportant for early detection of potentially cancerous lesions. Inmammography, the breast is compressed between two plates whilespecialized x-ray images are taken. If an abnormal mass in the breast isfound by physical examination or mammography, ultrasound may be used todetermine whether the mass is a solid tumor or a fluid-filled cyst.Solid masses are usually subjected to some type of tissue biopsy todetermine if the mass is cancerous.

If a solid mass or lesion is large enough to be palpable, a tissuespecimen can be removed from the mass by a variety of techniques,including but not limited to open surgical biopsy, a technique known asFine Needle Aspiration Biopsy (FNAB) and instruments characterized as“vacuum assisted large core biopsy devices”.

If a solid mass of the breast is small and non-palpable (e.g., the typetypically discovered through mammography), a biopsy procedure known asstereotactic needle biopsy may be used. In performing a stereotacticneedle biopsy of a breast, the patient lies on a special biopsy tablewith her breast compressed between the plates of a mammography apparatusand two separate x-rays or digital video views are taken from twodifferent points of view. With the assistance of a clinician, a computercalculates the exact position of the lesion in the breast. Thereafter, amechanical stereotactic apparatus is programmed with the coordinates anddepth information calculated by the computer and such apparatus is usedto precisely advance the biopsy needle into the lesion. Depending on thetype of biopsy needle(s) used, this stereotactic technique may be usedto obtain histologic specimens e.g., obtained through coring needlebiopsy or, more commonly, a biopsy with a vacuum assisted large corebiopsy device. Usually at least five separate biopsy specimens areobtained at or around the lesion.

The available treatment options for cancerous lesions of the breastinclude various degrees of lumpectomy or mastectomy and radiationtherapy, as well as chemotherapy and combinations of these treatments.However, radiographically visible tissue features, originally observedin a mammogram, may be removed, altered or obscured by the biopsyprocedure, and may heal or otherwise become altered following thebiopsy. In order for the surgeon or radiation oncologist to directsurgical or radiation treatment to the precise location of the breastlesion several days or weeks after the biopsy procedure was performed,it is desirable that a biopsy site marker be placed in or on thepatient's body to serve as a landmark for subsequent location of thelesion site. A biopsy site marker may be a permanent marker (e.g., ametal marker visible under X-ray examination), or a temporary marker(e.g., a bioresorbable marker detectable with ultrasound). While currentradiographic type markers may persist at the biopsy site, an additionalmammography generally must be performed at the time of follow uptreatment or surgery in order to locate the site of the previous surgeryor biopsy. In addition, once the site of the previous procedure islocated using mammography, the site must usually be marked with alocation wire which has a hook on the end which is advanced into site ofthe previous procedure. The hook is meant to fix the tip of the locationwire with respect to the site of the previous procedure so that thepatient can then be removed from the confinement of the mammographyapparatus and the follow-up procedure performed. However, as the patientis removed from the mammography apparatus, or otherwise transported theposition of the location wire can change or shift in relation to thesite of the previous procedure. This, in turn, can result in follow-uptreatments being misdirected to an undesired portion of the patient'stissue.

As an alternative or adjunct to radiographic imaging, ultrasonic imagingand visualization techniques (herein abbreviated as “USI”) can be usedto image the tissue of interest at the site of interest during asurgical or biopsy procedure or follow-up procedure. USI is capable ofproviding precise location and imaging of suspicious tissue, surroundingtissue and biopsy instruments within the patient's body during aprocedure. Such imaging facilitates accurate and controllable removal orsampling of the suspicious tissue so as to minimize trauma tosurrounding healthy tissue.

For example, during a breast biopsy procedure, the biopsy device isoften imaged with USI while the device is being inserted into thepatient's breast and activated to remove a sample of suspicious breasttissue. As USI is often used to image tissue during follow-up treatment,it may be desirable to have a marker, similar to the radiographicmarkers discussed above, which can be placed in a patient's body at thesite of a surgical procedure and which are visible using USI. Such amarker enables a follow-up procedure to be performed without the needfor traditional radiographic mammography imaging which, as discussedabove, can be subject to inaccuracies as a result of shifting of thelocation wire as well as being tedious and uncomfortable for thepatient.

Placement of a marker or multiple markers at a location within apatient's body requires delivery devices capable of holding markerswithin the device until the device is properly situated within a breastor other body location. Accordingly, devices and methods for retainingmarkers within a marker delivery device while allowing their expulsionfrom the devices at desired intracorporeal locations are desired.

SUMMARY OF THE INVENTION

The invention is directed to a fibrous, swellable marker which positionsa long-term radiographically detectable marker element within a targetsite of a patient's body. Preferably, short term ultrasound detectablemarkers are also delivered into the target site along with the fibrousmarker.

The fibrous marker embodying features of the invention is formed atleast in part of a fibrous material, such as oxidized, regeneratedcellulose, polylactic acid, a copolymer of polylactic acid and glycolicacid, polycaprolactone, in a felt and/or fabric or woven structure. Thefibrous marker material is swellable in the presence of body fluid, suchas blood or plasma, or other water based fluid. The fibrous material isformed into an elongated member and bound in a compressed condition toprovide sufficient column strength to facilitate introduction into anddischarge from a tubular delivery device. Suitable binding agents forholding the fibrous marker in a compressed condition are water solublepolymers such as polyvinyl alcohol, polyethylene glycol, polyvinylpyrollidone. One or more radiographically detectable marker elements areprovided with the fibrous marker, preferably centrally located, toensure that the radiographically detectable element is disposed at amore or less central location within the target site rather than at asite margin.

The one or more short term ultrasonically detectable markers, which arepreferably delivered with the fibrous markers, are formed ofbioabsorbable materials. Details of suitable short term ultrasonicallydetectable markers can be found in U.S. Pat. No. 6,161,034, issued Dec.12, 2000, U.S. Pat. No. 6,347,241, issued Feb. 12, 2002, applicationSer. No. 09/717,909, filed Nov. 20, 2000, now U.S. Pat. No. 6,725,083,and application Ser. No. 10/124,757, filed Apr. 16, 2002, now U.S. Pat.No. 6,862,470. These patents and applications are assigned to thepresent assignee and are incorporated herein in their entirety byreference.

Marker delivery systems embodying features of the invention include anelongated cannula with an inner lumen extending therein and a dischargeopening or port in a distal portion of the cannula which is in fluidcommunication with the inner lumen. The fibrous marker embodyingfeatures of the invention is slidably disposed within the inner lumen ofthe cannula, preferably along with at least one short term marker. Theshort term marker is preferably disposed distal to the fibrous marker sothat upon discharge from the cannula into a target site cavity, thefibrous marker will swell upon contact with body fluids to block theaccessing passageway. The discharge opening of the delivery device ispreferably closed with a plug to hold in the markers during handling anddelivery and to prevent tissue and fluid from entering the inner lumenthrough the discharge opening during delivery. Any water based fluidwhich may enter into the inner lumen of the delivery device can resultin the expansion or swelling of the marker bodies within the inner lumenand prevent their deployment. Preferably, the plug is formed of a waterswellable material, so that the plug occludes the opening upon contactwith a water based fluid and thereby prevents the premature expansion ofthe markers within the inner lumen. The plug is easily pushed out of thedischarge opening of the tubular delivery device.

A movable plunger is slidably disposed within the inner lumen of thedelivery cannula from an initial position accommodating the marker ormarkers and the plug within the tube, to a delivery position to push amarker against the plug to push the plug out of the discharge openingand to then eject one or more markers through the opening into thetarget tissue site.

Upon being discharged into the intracorporeal target site, the fibrousmarker swells on contact with body fluid, e.g. blood. The expandedfibrous marker fills or partially fills the cavity at the target site,positioning the radiopaque marker element within the interior of thetarget cavity. Additionally, a therapeutic agent, a diagnostic agent orother bioactive agent may be incorporated into the fibrous marker body.Such agents include a hemostatic agent to accelerate thrombus formationwithin the target cavity, an anesthetic agent, a coloring agent, anantibiotic agent, an antifungal agent, an antiviral agent, achemotherapeutic agent, a radioactive agent and the like.

The plug secures the discharge opening on the distal portion of thecannula, but it is easily ejected or removed from the orifice, allowingthe delivery of the markers to a desired site within a patient's body.The plug or the cannula itself may have retaining features, such asrecesses, protuberances, detents and the like which are configured toreleasably retain the plug or the short term markers proximal to theplug until ejection of the plug from the delivery tube is desired. Theretaining features may be complementary pairs, such as a plugprotuberance configured to fit into a recess in the cannula interior.For further plug details see application Ser. No. 10/174,401, filed onJun. 17, 2002, now U.S. Pat. No. 7,651,505, entitled Plugged TipDelivery Tube For Marker Placement. This application is assigned to thepresent assignee and is incorporated herein in its entirety byreference.

The invention, in one form thereof, is directed to an intracorporealmarker including a fibrous unitary marker body having bioabsorbablefibers compressed into a compressed configuration, and bound in thecompressed configuration by a polymer binding agent.

The invention, in another form thereof, is directed to an intracorporealmarker comprising a fibrous unitary marker body configured as a roll ofbioabsorbable fiber material having at least one wrap.

The invention, in another form thereof, is directed to an intracorporealmarker delivery device. The intracorporeal marker delivery deviceincludes a delivery cannula which has a distal tip, an inner lumen and adischarge opening in communication with the inner lumen. A fibrousunitary marker body includes bioabsorbable fibers compressed into acompressed configuration and bound in the compressed configuration by abinding agent prior to insertion into the inner lumen of the deliverycannula. The fibrous unitary marker body is slidably disposed within andpushable through the inner lumen of the elongated delivery cannulaproximal to the discharge opening.

The invention provides the advantages of a relatively long term fibrousmarker which is easily deployed into a target site and which positions apermanent radiographically detectable marker element within a centralportion of the target site. When combined with short term ultrasoundmarkers, the target site is easily detected at a later date by personnelwith minimal training. These and other advantages of the invention willbecome more apparent from the following description when taken inconjunction with the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a partly cut-away perspective view of a marker deliveryassembly showing a fibrous marker embodying features of the inventionand several short term markers within a marker delivery device and aplug embodying occluding the discharge opening of the delivery device.

FIG. 1B is a transverse cross-sectional view of the marker deliveryassembly of FIG. 1A taken at line 1B-1B.

FIG. 1C is a transverse cross-sectional view of the marker deliveryassembly of FIG. 1A taken at line 1C-1C.

FIGS. 2A-2F schematically illustrate the manufacture and use of afibrous marker embodying features of the invention.

FIG. 3 is a partially cut away, perspective view of a human breasthaving a biopsy cavity from which a biopsy specimen has been removed,and showing the delivery of a marker to the cavity.

FIG. 4 schematically illustrates the deployment of a plurality ofmarkers, including a marker embodying features of the invention, into abiopsy cavity.

DETAILED DESCRIPTION OF THE INVENTION

A marker delivery assembly 10 embodying features of the invention andillustrated in FIGS. 1A-1C, includes a marker delivery cannula 11 whichhas an inner lumen 12, a plunger 13 slidably disposed within the innerlumen 12, a fibrous marker 14 and a plurality of short termultrasonically detectable markers 15 slidably disposed within the innerlumen, and a plug 16 occluding a discharge opening 17 in the distalportion of the cannula 11. The delivery cannula 11 has an elongatedshaft 18 which defines at least in part the inner lumen 12 and has ahandle 20 on the proximal end of the cannula shaft 18 to facilitatehandling and advancement of the device. The plunger 13 has a plungershaft 21 and a plunger handle 22 to facilitate advancement of theplunger shaft 21 within inner lumen 12 of cannula 11 to dischargemarkers 14 and 15 from the discharge opening 17 in the cannula. As showna plurality of short term ultrasonically detectable markers 15 aredisposed within the inner lumen 12 distal to the fibrous marker 14. Thecannula 11 has a sharp, tissue penetrating distal tip 23 to facilitateadvancement through tissue to the target site within the patient. A ramp24 within the discharge opening 17 of the cannula 11 is provided toguide the markers 14 and 15 out through the discharge opening 17.

The manufacture and use of fibrous marker 14 is schematicallyillustrated in FIGS. 2A-2F. A felt pad or mat 31 of oxidized,regenerated cellulose about 0.125 to about 0.375 inch (3.2-9.3 mm),preferably about 0.25 inch (6.4 mm) thick is compressed and impregnatedwith a 10% (Wt.) polyethylene glycol in a 70% isopropyl alcohol solutionto a mat about 0.03 to about 0.05 inch (0.76-1.3 mm) thick with a lengthof about 20 mm. A reduction in thickness of 80% or more may be suitable.The compressed mat 31 is cut up into elongated strips 32 with square ornear square transverse cross-sectional shapes. The strips 32 are wrappedin a fabric 33 of oxidized regenerated cellulose about 5 to about 10 mmin width and about 20 mm in length, compressed and impregnated with a10% PEG dispersion and then dried at elevated temperatures (e.g. about70° F. to about 150° F.) to a diameter of about 0.065 inch (1.65 mm).The fabric 33 should make at least one, preferably two or more completewraps about the strip 32. The wrapped and compressed strip may then becut to a desired length to form the fibrous marker 13. Alternatively,the uncompressed mat 31, the strip 32 and fiber wrap 33 may be providedat the desired length for the fibrous marker 13. A radiographicallydetectable marker element 34 may be formed of a radiopaque material suchas 316L stainless steel or titanium wire 35 (OD about 0.005-0.01 inch,0.13-0.25 mm) may then be crimped about or embedded in a central portion(or other desired portion) of the marker 14. The fibrous marker 14 isthen ready for deployment.

The delivery of the markers into the target site within a human patientis illustrated in FIG. 3. In this particular illustration, the biopsyspecimen has already been removed leaving a cavity 40 with the patient'sbreast 41. A guide cannula 42 remains in the patient from the biopsyprocedure. Marker delivery assembly 10 is held by the handle 20 and theshaft 18 thereof containing the markers 14 and 15 is introduced into theinner lumen 44 of the guide cannula 42. The delivery cannula 11 isadvanced within the inner lumen 44 until the discharge opening 17 of thedelivery cannula is disposed within the cavity 40. The operator thenpresses the handle 22 on plunger 13 to eject markers 14 and 15 out thedischarge opening 17. The pressure on the markers 14 and 15 issufficient to dislodge the plug 16 which closes off the dischargeopening 17. A ramp 24 provided in the discharge opening 17 ensures thatthe markers 14 and 15 and plug 16 are discharged from the deliverydevice into the biopsy cavity 40.

Once the markers 14 and 15 are disposed within the biopsy cavity 40, thefibrous marker 14 begins to swell from the body fluids located in thebiopsy cavity. The short term, markers 15 are preferably ejected firstand the fibrous marker 14 ejected last. This allows the fibrous marker14 to swell and unfurl so as to extend across a significant portion ofthe cavity 40. With a radiographically detectable wire or clip holding acentral portion of the marker 14 in a constricted condition, the markerexpands into a bow-tie could also place clip/wire to allow fullunrolling form rectangular mat shape, as shown in FIG. 4, to center theradiopaque marker element 34 within the cavity 40. This expansion willalso tend to block off the accessing passageway 43 leading to the cavity40 to prevent excursions of the markers 14 or other elements back intothe passageway 43 which can cause the physician to miss the biopsy sitecavity on subsequent examination. The marker 14 is schematicallyillustrated in FIG. 2F as having felt layer 32 over the entire surfaceof fabric layer 33. However, in a clinical setting the layer 32 willcover only a portion of the layer 33.

The fibrous marker is preferably formed of a felt and/or fiber materialformed of oxidized regenerated cellulose. However, the fibrous markermay be formed of a bioabsorbable polymer such as polylactic acid, aco-polymer of polylactic acid and glycolic acid, polycaprolactone,collagen and mixtures thereof, including mixtures with oxidizedregenerated cellulose. Suitable oxidized, regenerated cellulose includesSURGICEL™ from the Ethicon Division of Johnson & Johnson or othersuitably oxidized regenerated cellulose. The fibrous marker may beformed of naturally hemostatic materials such as oxidized, regeneratedcellulose or a hemostatic agent such as collagen or gelatin may beincorporated into the fibrous material to provide the hemostasis uponcontact with blood. A wide variety of other hemostatic agents may beincorporated into the marker. The thrombus formed by the hemostasis isformed very quickly to fill the cavity at the biopsy site and at leasttemporarily hold the markers 14 and 15 in position within the cavity.Anesthetic agents to control post procedure pain, chemotherapeuticagents to kill any residual neoplastic tissue, coloring agents (e.g.carbon black and methylene blue) for visual location of the biopsy site,may also be incorporated into the fibrous marker.

The radiopaque marker element is preferably clamped about the exteriorof the fibrous material. However, a suitable radiopaque marker may beincorporated or otherwise embedded into the fibrous material tofacilitate the location of the marker element by the fibrous markerwithin the biopsy cavity. The fibrous marker is generally configured tobe slidably disposed within the inner lumen of the delivery cannula, andbefore delivery is about 0.5 mm to about 12 mm, preferably about 1 toabout 8 mm in diameter and about 5 to about 30 mm, preferably about 10to about 25 mm in length. Upon contact with a body fluid or other waterbased fluid, the length of the fibrous marker remains about the same butthe wrapped structure unfolds upon swelling to a width of about 5 toabout 25 mm, usually about 10 to about 20 mm. With a radiopaque markerelement clamped about a center portion of the wrapped fibrous marker,the fibrous marker expands into a generally bow-tie shape when exposedto body fluids. However, even though secured to the fibrous marker, theradiopaque marker element need not restrict the expansion of the fibrousmarker.

The short term marker, which is primarily designed for ultrasounddetection over a period of several hours to several months, ispreferably formed of a bioabsorbable material such as polylacticacid-glycolic acid copolymer. However, the short term marker may beformed of other bioabsorbable materials including polylactic acid andporcine gelatin. The short term marker materials are processed toinclude bubbles about 20 to about 1000 micrometers in diameter forultrasound detection. The bubble formation is preferably formed by theaddition of sodium bicarbonate, but air may be physically incorporatedwhile mixing the bioabsorbable material. The life of a particular shortterm marker may be controlled by the molecular weight of the polymermaterial from which it is made, with the higher molecular weightsproviding longer marker life. Suitable short term markers include theGelMark, which is a gelatin based marker, and GelMark Ultra which is apolylactic acid-glycolic acid copolymer based marker, sold by thepresent assignee. See also U.S. Pat. Nos. 6,161,034, 6,427,081,6,347,241 and application Ser. No. 09/717,909, filed on Nov. 20, 2000,now U.S. Pat. No. 6,725,083, and application Ser. No. 10/174,401, filedon Jun. 17, 2002, now U.S. Pat. No. 7,651,505, which are incorporatedherein by reference in their entirety. The short term markers areconfigured to be slidably disposed within the inner lumen of thedelivery cannula and generally are about 0.5 mm to about 12 mm,preferably about 1 to about 3 mm in diameter, typically about 1.5 mm,and about 1 to about 20 mm, preferably about 2.5 to about 15 mm inlength. The short term markers are preferably shorter than the fibrousmarker.

The plug used to occlude the discharge opening of the delivery cannulamay be formed of the same material as the short term marker and indeedmay be employed as a short term marker itself. The plug is preferablyformed of or coated with polyethylene glycol which readily hydrates inthe presence of body fluids and which causes the plug to swell andocclude the discharge opening. This prevents premature contact betweenbody fluids and the markers within the inner lumen of the deliverydevice which can cause the markers to swell in the lumen and prevent orretard their deployment to the target site.

An operator may grasp a device handle 20 to guide the device 10 duringinsertion, and to steady the device 10 during depression of the plunger13. Insertion of a device 10 results in the placement of at least aportion of the device 10 adjacent a desired location. The device 10, inparticular the distal tip 23 and orifice 17 of the device 10, may beguided adjacent a desired location such as a lesion site, or a biopsycavity, or other internal body site where delivery of a marker 14 isdesired.

The short term marker typically should remain in place and be detectablewithin a patient for a period of at least 2 weeks to have practicalclinical value, preferably at least about 6 weeks, and may remaindetectable for a time period of up to about 20 weeks, more preferablyfor a time period of up to about 12 weeks. The fibrous marker shouldhave a life period of short duration, e.g. less than 30 days but theradiographically detectable marker element of the fibrous marker shouldhave a life of at least one year and preferably is permanentlyradiographically detectable.

While stainless steel and titanium are preferred radiopaque materials,the radiopaque elements may be made of suitable radiopaque materialssuch as platinum, gold, iridium, tantalum, tungsten, silver, rhodium,nickel, NiTi alloy. MRI contrast agents such as gadolinium andgadolinium compounds, for example, are also suitable for use with plugsand/or markers embodying features of the invention.

Marker delivery devices other than those shown in FIGS. 1A-1C may beemployed. Other suitable delivery devices are depicted in U.S. Pat. No.6,347,241 and application Ser. No. 09/717,909, now U.S. Pat. No.6,725,083, which have been incorporated herein by reference.

While particular forms of the invention have been illustrated anddescribed herein, it will be apparent that various modifications andimprovements can be made to the invention. Moreover, those skilled inthe art will recognize that individual features of one embodiment of theinvention can be combined with any or all the features of anotherembodiment. Accordingly, it is not intended that the invention belimited to the specific embodiments illustrated. It is thereforeintended that this invention to be defined by the scope of the appendedclaims as broadly as the prior art will permit.

Terms such a “element”, “member”, “device”, “sections”, “portion”,“section”, “steps” and words of similar import when used herein shallnot be construed as invoking the provisions of 35 U.S.C. §112(6) unlessthe following claims expressly use the terms “means” or “step” followedby a particular function without specific structure or action.

All patents and patent applications referred to above are herebyincorporated by reference in their entirety.

What is claimed is:
 1. An intracorporeal marker delivery system,comprising: a delivery device including a delivery cannula and aplunger, the delivery cannula having an inner lumen, a distal tip, and adischarge opening in communication with the inner lumen, and the plungerhaving a plunger shaft slidably received in the inner lumen; aradiographically detectable marker having a fibrous body and aradiographically detectable marker element coupled to the fibrous body,the radiographically detectable marker disposed within and pushable bythe plunger through the inner lumen of the delivery cannula; an MRIdetectable distal tip plug configured to expand in the presence of bodyfluids, the MRI detectable distal tip plug disposed at least in partwithin a distal portion of the inner lumen distal to theradiographically detectable marker, and configured to partially occludethe discharge opening in the delivery cannula; and an ultrasounddetectable short term marker, the ultrasound detectable short termmarker being interposed between the radiographically detectable markerand the MRI detectable distal tip plug in the inner lumen of thedelivery cannula.
 2. The intracorporeal marker delivery system of claim1, wherein the radiographically detectable marker element isincorporated into the fibrous body.
 3. The intracorporeal markerdelivery system of claim 1, wherein the radiographically detectablemarker element is disposed about the fibrous body.
 4. The intracorporealmarker delivery system of claim 3, wherein the radiographicallydetectable marker element of the radiographically detectable marker isconfigured to constrict the fibrous body.
 5. The intracorporeal markerdelivery system of claim 1, wherein the MRI detectable distal tip plugincludes a plug body having an MRI contrast agent.
 6. The intracorporealmarker delivery system of claim 1, wherein the ultrasound detectableshort term marker is configured to include bubbles from about 20 toabout 1000 micrometers in diameter for ultrasound detection.
 7. Theintracorporeal marker delivery system of claim 1, wherein the ultrasounddetectable short term marker is 2.5 millimeters to 15 millimeters inlength, and is shorter than the fibrous body.
 8. The intracorporealmarker delivery system of claim 1, wherein each of the fibrous body andthe ultrasound detectable short term marker are bioabsorbable, thefibrous body and the ultrasound detectable short term marker beingconfigured such that the detection life of the fibrous body is shorterthan the detection life of the ultrasound detectable short term marker.9. The intracorporeal marker delivery system of claim 1, wherein atleast one of the radiographically detectable marker and the ultrasounddetectable short term marker further includes an MRI contrast agent. 10.An intracorporeal marker delivery system for delivering a plurality oftissue markers to a tissue site, comprising: a delivery device includingan elongated delivery cannula and a plunger, the elongated deliverycannula having an inner lumen, a distal tip, and a discharge opening incommunication with the inner lumen, and the plunger having a plungershaft slidably received in the inner lumen; a radiographicallydetectable marker including a bioabsorbable fibrous marker body thatcarries a radiographically detectable marker element, theradiographically detectable marker disposed within the inner lumen ofthe delivery cannula distal to the plunger shaft; an MRI detectabledistal tip plug configured to expand in the presence of body fluids, theMRI detectable distal tip plug disposed at least in part within a distalportion of the inner lumen distal to the radiographically detectablemarker, and configured to partially occlude the discharge opening in theelongated delivery cannula; and an ultrasound detectable short termmarker, the ultrasound detectable short term marker being interposedbetween the radiographically detectable marker and the MRI detectabledistal tip plug in the inner lumen of the elongated delivery cannula.11. The intracorporeal marker delivery system of claim 10, wherein theradiographically detectable marker element is incorporated into thebioabsorbable fibrous marker body.
 12. The intracorporeal markerdelivery system of claim 10, wherein the radiographically detectablemarker element is disposed about the bioabsorbable fibrous marker body.13. The intracorporeal marker delivery system of claim 12, wherein theradiographically detectable marker element of the radiographicallydetectable marker is configured to constrict the bioabsorbable fibrousmarker body.
 14. The intracorporeal marker delivery system of claim 10,wherein the MRI detectable distal tip plug includes a plug body havingan MRI contrast agent.
 15. The intracorporeal marker delivery system ofclaim 10, wherein the ultrasound detectable short term marker isconfigured to include bubbles from about 20 to about 1000 micrometers indiameter for ultrasound detection.
 16. The intracorporeal markerdelivery system of claim 10, wherein the ultrasound detectable shortterm marker is 2.5 millimeters to 15 millimeters in length, and isshorter than the bioabsorbable fibrous marker body.
 17. Theintracorporeal marker delivery system of claim 10, wherein theultrasound detectable short term marker is made of a bioabsorbablematerial, the bioabsorbable fibrous marker body and the ultrasounddetectable short term marker being configured such that the detectionlife of the bioabsorbable fibrous marker body is shorter than thedetection life of the ultrasound detectable short term marker.
 18. Theintracorporeal marker delivery system of claim 10, wherein at least oneof the radiographically detectable marker and the ultrasound detectableshort term marker further includes an MRI contrast agent.
 19. Anintracorporeal marker delivery system for delivering a plurality oftissue markers to a tissue site, comprising: a delivery device includingan elongated delivery cannula and a plunger, the elongated deliverycannula having an inner lumen, a distal tip, and a discharge opening incommunication with the inner lumen, and the plunger having a plungershaft slidably received in the inner lumen; a radiographicallydetectable marker including a bioabsorbable fibrous marker body thatcarries a radiographically detectable marker element, theradiographically detectable marker disposed within the inner lumen ofthe delivery cannula distal to the plunger shaft; a distal tip plugconfigured to expand in the presence of body fluids, the distal tip plugdisposed at least in part within a distal portion of the inner lumendistal to the radiographically detectable marker, and configured topartially occlude the discharge opening in the elongated deliverycannula; and an ultrasound detectable short term marker, the ultrasounddetectable short term marker being interposed between theradiographically detectable marker and the distal tip plug in the innerlumen of the elongated delivery cannula, wherein at least one of theradiographically detectable marker, the ultrasound detectable short termmarker, and the distal tip plug further includes an MRI contrast agent.